Balanitis is an inflammation of the glans penis. Men with balanitis often present with penile pain and erythema. This activity explains the risk factors, evaluation, and management of balanitis and highlights the importance of the interprofessional team in enhancing care for affected patients.
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Balanitis is an inflammation of the glans penis (head of the penis); it is fairly common and affects approximately 3-11% of males during their lifetime. Posthitis is an inflammation of the foreskin (prepuce). Balanoposthitis involves both the glans and the foreskin and occurs in approximately 6% of uncircumcised males. Balanoposthitis occurs only in uncircumcised males.[1][2] However, balanitis and balanoposthitis often occur together, and the terms are commonly used interchangeably. Infectious etiologies of balanitis include certain fungi like yeast and certain bacteria or viruses (including those that cause STDs such as gonorrhea). Balanitis is not a sexually transmitted infection. The actual disease is not transferable from one person to another; however, the transfer of organisms that cause balanitis is possible. Recurrent episodes of balanoposthitis should raise the concern for occult diabetes. Patients with recurrent episodes should undergo blood glucose screening for diabetes and evaluation by a urologist.
Circinate balanitis: associated with reactive arthritis, characterized by small, shallow, painless ulcerative lesions on the glans penis. A biopsy can show pustules in the upper epidermis, similar in appearance to pustular psoriasis. There may also be a serpiginous annular dermatitis that often has a grayish white granular appearance with a "geographical" white margin.[8] This lesion can be mistaken for psoriasis on physical examination, and histological evaluation cannot reliably distinguish between the two disorders. The distinction between circinate balanitis and psoriasis is generally made clinically (history of reactive arthritis or psoriasis). If circinate balanitis is suspected clinically in a patient without known reactive arthritis, screening for STIs and testing for human leukocyte antigen (HLA)-B27 is advised.
Phimosis is an abnormal constriction of the opening in the foreskin that precludes retraction over the glans penis, results from chronic inflammation and edema of the foreskin. Development of phimosis often complicates sexual function, voiding, and hygiene. If the patient or medical staff forcibly retract the foreskin, paraphimosis (trapping of the foreskin) can occur.
Paraphimosis refers to the trapping of the foreskin behind the glans penis and is a urologic emergency. The constricting foreskin has become located proximal to the glans penis. Under these circumstances, the constricting band will limit the venous and lymphatic outflow while allowing continued arterial inflow. Over the course of minutes to hours, the glans will increase in size and become exquisitely painful and must undergo treatment by a urologist with reduction of the paraphimosis.
Boorman GA, Elwell MR, Mitsumori K. 1990. Male accessory sex glands, penis, and scrotum. In: Pathology of the Fischer Rat: Reference and Atlas (Boorman GA, Eustis SL, Elwell MR, Montgomery CA, MacKenzie WF, eds). Academic Press, San Diego, 419-428. Abstract: 2ff7e9595c
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